Rigorous evaluation of large-scale community-based obesity interventions can provide important guidance to policy and decision makers. The eat well be active (ewba) Community Programs, a five-year multilevel, multistrategy community-based obesity intervention targeting children in a range of settings, was delivered in two communities. A comprehensive mixed-methods evaluation using a quasiexperimental design with nonmatched comparison communities was undertaken. This paper describes the changes in primary school children's attitudes, behaviours, knowledge, and environments associated with healthy eating and physical activity, based on data from six questionnaires completed pre- and postintervention by students, parents, and school representatives. As self-reported by students in years from five to seven there were few significant improvements over time in healthy eating and physical activity behaviours, attitudes, knowledge, and perceived environments, and there were few changes in the home environment (parent report). Overall there were considerably more improvements in intervention compared with comparison schools affecting all environmental areas, namely, policy, physical, financial, and sociocultural, in addition to improvements in teacher skill and knowledge. These improvements in children's learning environments are important and likely to be sustainable as they reflect a change of school culture. More sensitive evaluation tools may detect behaviour changes. 1. Introduction Evidence from evaluations of large-scale community-based interventions is building and suggests that modest improvements in child weight status can be achieved by multistrategy investments [1, 2]. Theoretical models guiding such interventions suggest that targeting behaviours, attitudes, knowledge, and skills at multiple levels, for example, individuals, teachers/leaders, and environment levels such as neighbourhood and school, environment types such as policy and culture, is likely to be most successful at slowing unhealthy weight gain [3–5]. Community-based, capacity-building approaches aim to promote sustainable skill development, thus improving environments that promote health outcomes [6]. The interaction between individuals’ behaviour and their broader environments that influence eating and activity is complex, but recent systematic reviews of promising interventions suggest that core components of community-based programs aimed that school-aged children should include elements such as changes to school curriculum, number of physical activity sessions, food supply,
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